Baby friendly – but is it woman friendly?

Manchester’s largest maternity unit, St Mary’s, is set to become a Unicef-approved ‘Baby Friendly’ hospital by ceasing to provide free formula milk to the women who give birth there.

According to an article in the Manchester Evening News, women who choose to formula feed at St Mary’s will have to bring their own ready prepared milk in cartons from this November; powdered milk will be banned for health and safety reasons. And the word from St Mary’s is clear: the new move is not a cost-cutting exercise but a way to ‘encourage’ more new mothers to breast feed their children.

Staff at St Mary’s are quoted as saying:

“We are still providing formula for babies and mothers whose medical needs mean that breastfeeding is not appropriate.”

“Today on our post-natal ward we have got 56 women who are in-patients […] only five are choosing to bottle feed their babies. Of that five, three of these mums we would still provide infant feeding formula post November due to medical conditions either in themselves or the baby. It is the way women are moving forward. We are just responding to the women’s needs.”

This quote neatly sidesteps a couple of issues. Firstly, what exactly constitutes a ‘medical condition’? Do cracked, sore and bleeding nipples count or does the woman’s health have to be at serious risk? What if the woman is in serious pain or has had a traumatic birth and feels too distressed to breast feed? In the event that a woman claims she is ‘unable’ to breastfeed, who gets to make the final decision? With hospital staff being pushed to limit formula feeding and educate the charmingly dubbed ‘reluctant feeders’ (as per Unicef’s guidelines), it seems unlikely that the decision will be an impartial one.

The second issue is that the staff at St Mary’s are not “responding to the needs” of those women who choose not to breastfeed. On the contrary, they are ‘encouraging’ women to breastfeed, not through increased education, but by removing the option of freely available formula. While women who know in advance that they will not be breastfeeding are invited to purchase their own liquid formula, no mention is made of how women who decide post-birth are supposed to get access to formula.

In the discussions I have observed, the question of whether a woman ‘should’ be given free formula milk is consistently answered by whether she is ‘physically able’ to breastfeed and has tried to do so. I have only seen only two commenters make it clear that a woman not wanting to breastfeed was acceptable. Interestingly, many women who initially seem in favour of being able to formula feed also seem keen to stress that formula is, of course, only an acceptable option for women who “can’t” breast feed.

While some members of the anti-formula camp seem willing to admit, briefly and grudgingly, that women with ‘medical conditions’ should be able to use formula, the message is clear: this should be a rare case.

When confronted with the idea of choice, many anti-formula commenters questioned how ‘informed’ women could really be if they chose to formula feed. Many suggested that women avoided breastfeeding because they could not disassociate their breasts from their sexuality. While the question of the sexualisation of women’s bodies is undoubtedly a valid one, there continues to be systematic denial that there could be valid reasons for a woman to not want to breast feed, even in the face of personal testimony from the women concerned. Women’s negative breastfeeding experiences are being systematically and publicly invalidated.

In an era when many feminists are (in my opinion rightly) dismayed by the suggestion that a woman’s right to an abortion should be subject to conditions, I have been shocked by the high level of acceptance when it comes to the notion that women who formula feed should be forced to justify their choice, not only to medical staff, but to pro-breastfeeding women. While I have never seen anyone claim that formula is better than – or even equal to – breast milk, a large number of women are vociferously and uncompromisingly against a woman’s right to choose formula milk. I have witnessed a sizeable number of women, some of whom are self-declared feminists, debating on one another’s social media profiles and calling for formula to be made illegal.

The tendency to remove agency and autonomy from women who have had children is something that I find highly disturbing. While many women would claim that they are not being “reduced” to the status of “mum”, the discourse that surrounds breast-feeding tells a different story: “But it’s best for baby” continues to be the phrase on the flag. When, exactly, people stopped prioritising what’s best for women is a question that remains to be answered.

[The image is a photograph of a baby wearing blue and white stripes, holding and drinking from a bottle of milk. It was taken by nerissa and is used under a Creative Commons Licence]

Comments From You

Hear, hear! A fantastic post, and a really important feminist point that needs to be made. I am horrified by how guilty and unsupported female friends of mine who choose to or have to formula feed are often made to feel, both by the medical establishment and by supposedly feminist friends.

I actually agree with the Manchester decision. That’s not to say that I feel that any woman should ever be made to feel bad about a choice she makes. Her choice isn’t restricted at all. However, I don’t think that the hospital should have to provide free formula.

There are risks associated with formula feeding – thankfully here we have access to a clean, safe water supply, so those risks aren’t so immediately dangerous. However, human milk, as the Dundee Infant Feeding Study shows, is a great leveller in terms of health inequalities. Professor Stewart Forsyth’s research shows that an affluent formula fed child is worse off in health terms than a breastfed child from a poor background. We can’t ignore evidence like that. It’s not fair to women to lie to them and tell them that breast and formula milk are the same thing.

I would hope, though, that there is decent support on the ward to help mothers to breastfeed if they are having trouble.

Very few will be in hospital long enough to develop cracked and bleeding nipples as many leave within hours of the birth, before they have had time to develop. I do not deny the pain, because I have been there, but with the correct support, whatever is causing the problem can be fixed. The issue is that often midwives don’t have the correct training, or they choose not to apply it. Doctors generally don’t have the first clue about practical management of breastfeeding and can be quite negative about it.

If people have had a traumatic birth, then you would expect that their baby would be provided with the formula. We need to see hard evidence of that not happening before we can condemn I think.

One thing that I think would be really useful would be ante-natal in depth breastfeeding classes which go through all sorts of scenarios and give parents information on which to base their decisions.

As I said, women must have the right to choose from themselves what they do and not be judged by health professionals. I don’t think, though, that they have a right to expect the hospital to provide the formula. There has been a huge imbalance – health priorities clearly indicate that breast milk is by far better for the baby, yet we spend a fortune on supporting formula feeding. I’d rather see the resources spent on formula going to support breastfeeding – because in my experience, every breastfeeding problem has a breastfeeding solution.

I want to make it clear I think that choosing not to breast feed is fine. What is not fine is having your choice removed by a hospital that is really not interested in you but is actually just looking out for its bottom line. I did not breast feed my two children. I did not even try. I have no shame about it. I feel no need to defend my actions or explain myself to anyone. If anyone wonders they have turned out to be pretty healthy, nice, normal children. Formula is an acceptable option for any woman. I trust women to make the choices that feel right to them. I think other people should too. If you don’t agree with the use of formula you do not have to use it. Shaming someone else for their choice is just a way of dehumanizing someone who is different from you. Having a child does not make me a robot or a drone whose only purpose is to do state authorized actions. I’m glad you did this post as I have noticed the same attitude and am disturbed by it. Truth is, I feel like people who try to shame people into decisions or force them with economics are control freaks. It’s not about what’s right for anyone, it’s about pushing what you think is right onto another, because of course you are better than them.

I don’t accept that increased consumer behaviour is empowering or liberating, which is essentially what the choice not to breastfeed is. It’s also not just “best for baby” but has a number of positive health implications for mothers. The health system encouraging people to do what’s best for their own and their child’s health? Isn’t that kind of what health systems are for? Negative health choices, like smoking, drinking to excess, not breastfeeding, are choices people are free to make (and it’s not bystanders’ place to judge what factors led them to that choice), but they’re not the best health choices and nor should we pretend they are.

Yes, I breastfed. No, it wasn’t instantly easy (I wrote an article for the F Word about it, further details there: /features/2009/01/breastfeeding_r ). I also breastfed while on psychiatric drugs, and have been judged negatively for that. We all do the best we can as parents, and “best” is a complex word taking in the needs of mothers and children, other parents, and whole families and communities. But promoting positive health choices is the least I’d expect from the NHS; being taken in by the “buy and be liberated” rhetoric of the artificial baby milk industry is less than I’d expect of a rigorous feminist analysis.

I have been boycotting Nestle for over 20 years for this very reason (my kids even reject nestle bars, evian and loreal!). It makes me so happy to see a major health provider in the Western world take a stand in favour of the health of babies over profit. Well done!

Is it woman friendly? Yes, it is. It’s October and Breast Cancer Awareness month, but instead of being encouraged to buy something pink, you should be encouraged to breastfeed, because breastfeeding – the longer you do it, and the more children you have – dramatically lowers your risk for breast cancer. Or should I say, breastfeeding is the biological norm, and formula feeding increases your risk. Breastfeeding is PRO woman, it lowers your risk for other cancers, diabetes, depression, and osteoporosis. Post partum, it contracts the uterus and gets it back into shape. Hospitals should promote health. You want to formula feed then buy your own formula. The formula freebies provides by the hospitals are provided by unethical formula companies whose only goal is to get you to give up on what your body is able to do and buy their product. Giving up your power to breastfeed, buying a product that costs money and requires you to be dependent on it, a product that is highly comprised of the milk of another species and corn syrup, made by companies that mislead you into thinking their product could be anywhere close to the living composition of breastmilk, is anti woman. And anti baby. The health benefits of breastfeeding are extensive, and provide lifelong benefits for your children, it’s a daily immunization, it’s a constant source of health and protection. No one is going to outlaw formula and no one is going to take your choice away. But if you are going to defend anything as pro woman, you should be defending what is is actually pro women’s health, something that is empowering to women, instead of a product that a megacorporation is selling you. Because as a woman, you naturally make a far better product all on your own without anyone else’s help.

I think this is a brilliant move by St Mary’s, it’s fantastic how much they want to promote breastfeeding, but I am concerned by them moving very into doing this without providing sufficient post-natal care. The post-natal care in this country is appalling. You very rarely hear of any hospital that has enough midwives, providing enough support and the breastfeeding advice and support is even worse. There should be specialist counsellors on every maternity ward, at all times of day and night, because that’s when babies feed, but I didn’t even see the counsellor when I was in hospital and, having just had twins, one who was underweight (and did briefly have to be formula fed; I suspect we would qualify under St Mary’s new regulations for who can be provided free formula) and struggling like mad, I would have appreciated having someone who could have just told me what was going wrong in the 4 days I was there. Eventually after 2 weeks of struggling being at the brink of giving up again and again and again, I went out and found my own support from a breastfeeding drop-in centre. I’m still angry with how little post-natal breastfeeding support was provided and I don’t know many twins mothers who feel differently.

I think this article is attacking the wrong thing. I think the NHS should be promoting breastfeeding every way they can, it’s really sad how many women don’t breastfeed anymore – particularly when it really is the easiest option in terms of ease and cost. If women don’t want to follow health advice that’s up to them but I agree with the decision that women shouldn’t be so easily provided with formula. Instead, attack the shocking lack of postnatal care that makes it harder to breastfeed for so many women.

I think this scheme is right, as long as there is a backup for women who plan to breast feed but who change their minds at the last minute – which I’m sure there is; at the end of the day a hospital is NOT going to let a hungry baby scream if a woman can’t be discharged yet and doesn’t have any formula with her.

I’m currently training as a La Leche League Peer Support Counsellor to help support women who want to breastfeed. BUT – I strongly believe that ‘because I don’t want to’ is, actually, a good enough reason not to breastfeed.

I hope that with the correct information and support that more women will at least try. But if they don’t want to, who am I to say they should? I don’t think people should feed their babies big bags of crisps for breakfast either, but i’d never dream of criticising a woman (or man, for that matter) who I saw do so.

The reality is that the comparison between breast milk and formula is a one horse race, as far as meeting the nutritional needs of the infant go, but the psychological needs of the mother are seen as of minor or no importance, and that is decidedly non-feminist… If the hardcore breastfeeding activists really want to achieve a higher level of breastfeeding for all babies, they need to look at targetting a selfish society which often does not provide the support new mothers need rather than accusing mothers themselves of selfishness

I share your anger and disbelief that the conversation has been so one-sided and tunnel-visioned. Supporting the choice to feed our babies the way we want to – from our bodies or not – is a completely different issue than the “evils” of formula company marketing. It’s like saying we should outlaw abortion because the makers of beer and ecstasy have encouraged people to have unprotected sex. Just ludicrous.

The science of breast v formula is far from black and white. Most of the benefits of breastfeeding are measured in very small percentages when compared with formula milk (so might be in what would be considered an acceptable risk), and some are downright misrepresented.

So, for example, if you breastfeed you may have less chance of breastcancer before you stop menstruating, but may actually have a higher risk later. Breastfed babies receive immunity to certain diseases through their mother’s milk, so get less illnesses when being breastfed, but tend to have more after they stop being breastfeeding and they have to develop their own immunities (which non-breastfed children have already developed) etc.

So to say that breast is the best for health is not straightforwardly true; in fact, there are competing benefits to both. And, why shouldn’t a women’s needs (to work, to make choices about her own body) be considered a factor in determining what’s best for her health, which presumably includes mental well-being.

Most contraceptions have negative health consequences, as well as positive ones, but we wouldn’t say that doctors should promote abstinence as the most healthy method, but refuse to teach on contraception due to its risks. So, why do we think this should be the case with breastmilk?

Taking free formula out the hospitals doesn’t limit women’s choices. Women can still choose formula. They will just have to pay for it just like after they go home. When hospitals don’t have to pay for formula, and the formula companies just give them a ton of it (free marketing), that does hurt moms and babies. It gets handed out like candy and sent home with moms who do want to breastfeed and sabotages their efforts when they are still learning the dance of breastfeeding. Formula companies know this. That’s why they do it. Most hospitals don’t care because it saves them a ton of money. When they have to buy it, they give it to the mothers who need it.

Feminist Avatar, you completely misunderstand how the immune system works. If you get illnesses before you’re 1, you are very unlikely to have a developed enough immune system to protect yourself from getting illnesses again. Yes, a baby breastfed until they’re 1 will get an illness when they’re no longer breastfed, but a formula-fed baby is very likely to get the same illness twice (or more times) until their immune system is developed enough to cope with it. That is why/how breastfeeding protects the immune system.

Bex, I’m not an immune system specialist, but your comment implies that breast fed babies never get infections, which clearly isn’t the case. I’m not sure whether you intended to convey that meaning or not, but I wanted to clarify that breast fed babies do get bugs and eczema and other illnesses as well as bottle fed ones.

Bex: that’s a bit of an overstatement. Babies have an immature immune system, so they don’t build up as many antibodies as older child after an infection, but they do develop some. So this means they will respond better (get well quicker) to the same diseases/infections if they come in to contact with them as older children or adults. We start vaccinating babies from around 2 months because this works; if it was a waste of time we wouldn’t bother. And, while immunity builds over time, children often need to get an illness several times to have a full immunity long past the recommended breastfeeding period, so this is not a problem exclusive to non-breastfed babies.

I work on a maternity ward and whilst we do provide formula milk in emergency cases, the general rule is: if you want to formula feed your newborn, bring your own milk.

This may seem harsh, but it isn’t actually intended to be brutal.

Just to give one example:

A 19 year-old new mother had just come out of surgery where she’d had her 3rd-degree tear sutured. Immediately after surgery she decided to put her newborn son to her breast, and after five minutes of trying and not succeeding told herself (and me) that she was “a sh*t mum” because she couldn’t breastfeed her baby, and asked me if she “could just give him a bottle”. To cut a long story short, we (myself and her) tried again a couple of hours later and fortunately her baby latched on and fed.

Now, I would definitely say I encouraged her to breastfeed. Assessing the situation, I saw the baby seemed fine and not in need of a feed. My encouragement came in the form of suggesting we try again when the mother had rested more following her surgery, and had spent some time with her new son, particularly seeing as he’d been whisked away so soon after delivery.

The reason I didn’t give her a bottle wasn’t just because of the fact that I’m aware that breast milk is the best type of milk, or because of the ward’s policy, but because I was actually supporting her. I saw she really wanted to breastfeed and so suggested she give it another shot, which on this instance turned out to be successful.

Not all women can immediately breastfeed with ease, and while St Mary’s will longer give out free formula milk, if they are anything like the ward I work on, they will have ward staff that are trained to help women breastfeed, and perhaps even a specific “breastfeeding lady” whose only role is to help those women who are struggling to breastfeed (and wish to breastfeed).

Yes, I held off on the formula but she certainly wasn’t left out to dry. In my opinion I was absolutely responding to her needs: her desire to breastfeed her baby, just as she’d indicated to me.

I’m not too convinced it’s not *part* of a cost-cutting exercise, they have to pull in where they can and this will help out with the costs. Call me cynical but while i believe they are doing it to promote breast feeding, i also think it’s a cost issue too. I know the NHS is about ‘public health’ not buisiness but when the two cross over I think they sometimes use it as an excuse.

A lot of Hospitals promote breast feeding and i don’t disagree with it, i very much support, and if they want to charge for formula on the basis of healthcare and cost then that’s their choice, but women should always be offered a choice of breasting feeding or formula feeding. By asking people to pay for it you recoup costs and allow women that choice-and it is their choice. By stopping it entirely you are trying to dictate and pressuring someone who may not want to breast feed.

Feminist Avatar: We do a course of vaccines – at 8, 12, 16 weeks – to offer babies some protection while they have underdeveloped immune systems but they have to be carried out more than once and then topped up at a year (and later) for exactly that reason, that they will not have established immunity before then.

Philippa: Yes, babies are going to get infections regardless of whether or not they’re breastfed but I was responding to the statement by Feminist Avatar that “Breastfed babies receive immunity to certain diseases through their mother’s milk, so get less illnesses when being breastfed, but tend to have more after they stop being breastfeeding and they have to develop their own immunities (which non-breastfed children have already developed)”, which simply isn’t true. (And I am an immunologist!)

This was a great post, but I would just like to correct one factual error: Becoming a UNICEF-approved ‘Baby-Friendly’ hospital does *not* require taking this step. The UNICEF guidelines do clearly allow for providing formula when women have made fully informed choices to formula-feed. So, in fact, this hospital has gone a step further and decided to get that bit more authoritarian about it. I wanted to make that point because this seems to have led to some unnecessary confusion about what the UNICEF guidelines do or don’t allow.

Other than that, excellent post. I do not appreciate it when healthcare professionals take it upon themselves to decide that they know better than me what my ‘needs’ are when it comes to making parenting choices. (And, by the way, I breastfed both of mine. I just don’t appreciate the implication that, had I chosen to give them formula in the newborn phase, it would have been in accordance with my ‘needs’ for hospital staff to refuse to provide it.)

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